Bob, I agree. But does this need only belong to the 835 transaction. One could make this assumption based on other messages to this list that the provider doesn't get that directly involved with the payer for claims submissions. I find it difficult to assert that the provider and payer must interact directly for the 835 but then stay at arm's length for claims and other HIPAA transactions. This doesn't hang together from an overall process basis.
So, a question to be answered is the relationship between the provider and the payer when exchanging HIPAA transactions - the IG's are focused only very narrowly on a discrete information exchange and the entire process doesn't seem to be addressed appropriately. In my opinion, this whole effort is crying for a good process analysis effort rather than just discrete and disjointed message exchanges. Rachel -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] Sent: Friday, January 25, 2002 7:25 AM To: [EMAIL PROTECTED] Cc: [EMAIL PROTECTED] Subject: RE: Time-out for terminology question(s) There are additional issues with the 835. HIPAA does not link the 835 with the 837. A provider can ask for the 835 without sending electronic claims. Providers sometimes send claims through multiple routes. They can even want to the 835 to return through a different route (like a bank). The payer must be told when a provider wants an 835 and which route to use. Sending information down the wrong route can be a privacy problem. To keep it short - there is NO substitute for provider to payer communications for the 835. Bob Dave Minch <dave.minch@jm To: [EMAIL PROTECTED] mdhs.com> cc: [EMAIL PROTECTED] Subject: RE: Time-out for terminology question(s) 01/24/2002 06:43 PM William, I would guess that, following the pattern that appears to be present for claim submission which i just finished commenting on, routing of the 835 or 277 would not depend so much on the ISA sender as it would on the 1000A submitter. The 1000B receiver would have to have my "first-hop" address to put into the ISA to respond to me. If that is true, does it imply that i actually need to have a TPA with every payer i send information to? (yuck..!!) or if I use a CH, is it their job to update the next hop's routing tables (same question that you just asked), and so forth until the payer's routing tables are eventually updated with my submitter id & route information? How does it work today when the paths are: Claim: provider ---> prov's CH ---> payer's CH ---> payer Remittance: payer ---> prov's CH ---> provider (note the omission of the payer's CH) Dave Minch T&CS Project Manager John Muir / Mt. Diablo Health System Walnut Creek, CA (925) 941-2240
